|
HC EXTREMITY STUDY COMPLEX
|
Facility
|
IP
|
$1,719.00
|
|
|
Service Code
|
CPT 93923
|
| Hospital Charge Code |
908100119
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$343.80 |
| Max. Negotiated Rate |
$1,547.10 |
| Rate for Payer: Cash Price |
$773.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,375.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$687.60
|
| Rate for Payer: Galaxy Health WC |
$1,461.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,031.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,547.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,146.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$654.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$343.80
|
| Rate for Payer: Multiplan Commercial |
$1,289.25
|
| Rate for Payer: Networks By Design Commercial |
$1,117.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,461.15
|
|
|
HC EXTREMITY STUDY COMPLEX
|
Facility
|
OP
|
$1,719.00
|
|
|
Service Code
|
CPT 93923
|
| Hospital Charge Code |
908100119
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$184.98 |
| Max. Negotiated Rate |
$1,547.10 |
| Rate for Payer: Adventist Health Medi-Cal |
$195.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$900.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$195.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$589.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,015.59
|
| Rate for Payer: Blue Distinction Transplant |
$1,031.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,062.34
|
| Rate for Payer: Blue Shield of California EPN |
$835.43
|
| Rate for Payer: Caremore Medicare Advantage |
$195.17
|
| Rate for Payer: Cash Price |
$773.55
|
| Rate for Payer: Cash Price |
$773.55
|
| Rate for Payer: Cash Price |
$773.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,375.20
|
| Rate for Payer: Cigna of CA HMO |
$1,100.16
|
| Rate for Payer: Cigna of CA PPO |
$1,272.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$292.76
|
| Rate for Payer: Dignity Health Media |
$195.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$214.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$263.48
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$195.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$195.17
|
| Rate for Payer: Galaxy Health WC |
$1,461.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,031.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,547.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,289.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$320.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$322.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$195.17
|
| Rate for Payer: InnovAge PACE Commercial |
$292.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,146.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$184.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$195.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$343.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$261.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$261.53
|
| Rate for Payer: Multiplan Commercial |
$1,289.25
|
| Rate for Payer: Networks By Design Commercial |
$1,117.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,461.15
|
| Rate for Payer: Prime Health Services Medicare |
$206.88
|
| Rate for Payer: Riverside University Health System MISP |
$214.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,031.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,031.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,507.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,228.00
|
| Rate for Payer: United Healthcare HMO Rider |
$931.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$851.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Vantage Medical Group Senior |
$195.17
|
|
|
HC EXTREMITY STUDY SIMPLE
|
Facility
|
IP
|
$1,024.00
|
|
|
Service Code
|
CPT 93922
|
| Hospital Charge Code |
900803200
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$204.80 |
| Max. Negotiated Rate |
$921.60 |
| Rate for Payer: Cash Price |
$460.80
|
| Rate for Payer: Central Health Plan Commercial |
$819.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$409.60
|
| Rate for Payer: Galaxy Health WC |
$870.40
|
| Rate for Payer: Global Benefits Group Commercial |
$614.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$921.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$683.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$390.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$204.80
|
| Rate for Payer: Multiplan Commercial |
$768.00
|
| Rate for Payer: Networks By Design Commercial |
$665.60
|
| Rate for Payer: Prime Health Services Commercial |
$870.40
|
|
|
HC EXTREMITY STUDY SIMPLE
|
Facility
|
OP
|
$1,024.00
|
|
|
Service Code
|
CPT 93922
|
| Hospital Charge Code |
900803200
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$98.99 |
| Max. Negotiated Rate |
$1,507.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$159.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$596.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$159.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$312.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$604.98
|
| Rate for Payer: Blue Distinction Transplant |
$614.40
|
| Rate for Payer: Blue Shield of California Commercial |
$632.83
|
| Rate for Payer: Blue Shield of California EPN |
$497.66
|
| Rate for Payer: Caremore Medicare Advantage |
$159.60
|
| Rate for Payer: Cash Price |
$460.80
|
| Rate for Payer: Cash Price |
$460.80
|
| Rate for Payer: Cash Price |
$460.80
|
| Rate for Payer: Cash Price |
$460.80
|
| Rate for Payer: Central Health Plan Commercial |
$819.20
|
| Rate for Payer: Cigna of CA HMO |
$655.36
|
| Rate for Payer: Cigna of CA PPO |
$757.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.40
|
| Rate for Payer: Dignity Health Media |
$159.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$175.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.46
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$159.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$159.60
|
| Rate for Payer: Galaxy Health WC |
$870.40
|
| Rate for Payer: Global Benefits Group Commercial |
$614.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$921.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$768.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$261.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$263.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$159.60
|
| Rate for Payer: InnovAge PACE Commercial |
$239.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$683.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$98.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$159.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$204.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$213.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$213.86
|
| Rate for Payer: Multiplan Commercial |
$768.00
|
| Rate for Payer: Networks By Design Commercial |
$665.60
|
| Rate for Payer: Prime Health Services Commercial |
$870.40
|
| Rate for Payer: Prime Health Services Medicare |
$169.18
|
| Rate for Payer: Riverside University Health System MISP |
$175.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$614.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,507.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,228.00
|
| Rate for Payer: United Healthcare HMO Rider |
$931.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$851.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Vantage Medical Group Senior |
$159.60
|
|
|
HC EXTREMITY TEST ADD 15 MIN OT
|
Facility
|
OP
|
$166.00
|
|
|
Service Code
|
CPT 97721
|
| Hospital Charge Code |
903207721
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$58.10 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$100.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$141.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$91.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$91.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$99.60
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$74.70
|
| Rate for Payer: Cash Price |
$74.70
|
| Rate for Payer: Cash Price |
$74.70
|
| Rate for Payer: Central Health Plan Commercial |
$132.80
|
| Rate for Payer: Cigna of CA HMO |
$106.24
|
| Rate for Payer: Cigna of CA PPO |
$122.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$141.10
|
| Rate for Payer: Dignity Health Media |
$141.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$141.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$66.40
|
| Rate for Payer: Galaxy Health WC |
$141.10
|
| Rate for Payer: Global Benefits Group Commercial |
$99.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$149.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$124.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$58.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$110.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.06
|
| Rate for Payer: Multiplan Commercial |
$124.50
|
| Rate for Payer: Networks By Design Commercial |
$107.90
|
| Rate for Payer: Prime Health Services Commercial |
$141.10
|
| Rate for Payer: Riverside University Health System MISP |
$66.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$99.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$99.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$141.10
|
| Rate for Payer: Vantage Medical Group Senior |
$141.10
|
|
|
HC EXTREMITY TEST ADD 15 MIN OT
|
Facility
|
IP
|
$166.00
|
|
|
Service Code
|
CPT 97721
|
| Hospital Charge Code |
903207721
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$33.20 |
| Max. Negotiated Rate |
$149.40 |
| Rate for Payer: Cash Price |
$74.70
|
| Rate for Payer: Central Health Plan Commercial |
$132.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.40
|
| Rate for Payer: Galaxy Health WC |
$141.10
|
| Rate for Payer: Global Benefits Group Commercial |
$99.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$149.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$110.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.20
|
| Rate for Payer: Multiplan Commercial |
$124.50
|
| Rate for Payer: Networks By Design Commercial |
$107.90
|
| Rate for Payer: Prime Health Services Commercial |
$141.10
|
|
|
HC EXTREMITY TEST INIT 30 MIN OT
|
Facility
|
OP
|
$426.00
|
|
|
Service Code
|
CPT 97720
|
| Hospital Charge Code |
903207720
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$149.10 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$258.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$362.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$234.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$234.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$255.60
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$191.70
|
| Rate for Payer: Cash Price |
$191.70
|
| Rate for Payer: Cash Price |
$191.70
|
| Rate for Payer: Central Health Plan Commercial |
$340.80
|
| Rate for Payer: Cigna of CA HMO |
$272.64
|
| Rate for Payer: Cigna of CA PPO |
$315.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$362.10
|
| Rate for Payer: Dignity Health Media |
$362.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$362.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$170.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$170.40
|
| Rate for Payer: Galaxy Health WC |
$362.10
|
| Rate for Payer: Global Benefits Group Commercial |
$255.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$383.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$319.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$149.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$284.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$162.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$174.66
|
| Rate for Payer: Multiplan Commercial |
$319.50
|
| Rate for Payer: Networks By Design Commercial |
$276.90
|
| Rate for Payer: Prime Health Services Commercial |
$362.10
|
| Rate for Payer: Riverside University Health System MISP |
$170.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$255.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$255.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$362.10
|
| Rate for Payer: Vantage Medical Group Senior |
$362.10
|
|
|
HC EXTREMITY TEST INIT 30 MIN OT
|
Facility
|
IP
|
$426.00
|
|
|
Service Code
|
CPT 97720
|
| Hospital Charge Code |
903207720
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$85.20 |
| Max. Negotiated Rate |
$383.40 |
| Rate for Payer: Cash Price |
$191.70
|
| Rate for Payer: Central Health Plan Commercial |
$340.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$170.40
|
| Rate for Payer: Galaxy Health WC |
$362.10
|
| Rate for Payer: Global Benefits Group Commercial |
$255.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$383.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$284.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$162.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.20
|
| Rate for Payer: Multiplan Commercial |
$319.50
|
| Rate for Payer: Networks By Design Commercial |
$276.90
|
| Rate for Payer: Prime Health Services Commercial |
$362.10
|
|
|
HC EYE EXAM & TREAT W/CON SED LTD
|
Facility
|
OP
|
$4,892.00
|
|
|
Service Code
|
CPT 92019
|
| Hospital Charge Code |
900501662
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$81.89 |
| Max. Negotiated Rate |
$4,817.46 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,919.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$384.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,211.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,919.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,935.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3,077.07
|
| Rate for Payer: Blue Shield of California EPN |
$2,392.19
|
| Rate for Payer: Caremore Medicare Advantage |
$2,919.67
|
| Rate for Payer: Cash Price |
$2,201.40
|
| Rate for Payer: Cash Price |
$2,201.40
|
| Rate for Payer: Cash Price |
$2,201.40
|
| Rate for Payer: Central Health Plan Commercial |
$3,913.60
|
| Rate for Payer: Cigna of CA HMO |
$3,130.88
|
| Rate for Payer: Cigna of CA PPO |
$3,620.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Dignity Health Media |
$2,919.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,211.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,941.55
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,919.67
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,919.67
|
| Rate for Payer: Galaxy Health WC |
$4,158.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,935.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,402.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,669.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,788.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,817.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,919.67
|
| Rate for Payer: InnovAge PACE Commercial |
$4,379.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,262.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,919.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$978.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,912.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,912.36
|
| Rate for Payer: Multiplan Commercial |
$3,669.00
|
| Rate for Payer: Networks By Design Commercial |
$3,179.80
|
| Rate for Payer: Prime Health Services Commercial |
$4,158.20
|
| Rate for Payer: Prime Health Services Medicare |
$3,094.85
|
| Rate for Payer: Riverside University Health System MISP |
$3,211.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,935.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,935.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,446.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,446.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,446.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,446.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,211.64
|
| Rate for Payer: Vantage Medical Group Senior |
$2,919.67
|
|
|
HC EYE EXAM & TREAT W/CON SED LTD
|
Facility
|
OP
|
$4,892.00
|
|
|
Service Code
|
CPT 92019
|
| Hospital Charge Code |
900501662
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$81.89 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,919.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$384.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,211.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,919.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,935.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3,023.26
|
| Rate for Payer: Blue Shield of California EPN |
$2,377.51
|
| Rate for Payer: Caremore Medicare Advantage |
$2,919.67
|
| Rate for Payer: Cash Price |
$2,201.40
|
| Rate for Payer: Cash Price |
$2,201.40
|
| Rate for Payer: Cash Price |
$2,201.40
|
| Rate for Payer: Central Health Plan Commercial |
$3,913.60
|
| Rate for Payer: Cigna of CA HMO |
$3,130.88
|
| Rate for Payer: Cigna of CA PPO |
$3,620.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Dignity Health Media |
$2,919.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,211.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,941.55
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,919.67
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,919.67
|
| Rate for Payer: Galaxy Health WC |
$4,158.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,935.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,402.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,669.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,788.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,817.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,919.67
|
| Rate for Payer: InnovAge PACE Commercial |
$4,379.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,262.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,919.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$978.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,912.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,912.36
|
| Rate for Payer: Multiplan Commercial |
$3,669.00
|
| Rate for Payer: Networks By Design Commercial |
$3,179.80
|
| Rate for Payer: Prime Health Services Commercial |
$4,158.20
|
| Rate for Payer: Prime Health Services Medicare |
$3,094.85
|
| Rate for Payer: Riverside University Health System MISP |
$3,211.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,935.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,935.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$969.00
|
| Rate for Payer: United Healthcare All Other HMO |
$765.00
|
| Rate for Payer: United Healthcare HMO Rider |
$579.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$530.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,211.64
|
| Rate for Payer: Vantage Medical Group Senior |
$2,919.67
|
|
|
HC EYE EXAM & TREAT W/CON SED LTD
|
Facility
|
OP
|
$4,892.00
|
|
|
Service Code
|
CPT 92019
|
| Hospital Charge Code |
900501662
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$81.89 |
| Max. Negotiated Rate |
$4,788.26 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,211.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,919.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,935.20
|
| Rate for Payer: Caremore Medicare Advantage |
$2,919.67
|
| Rate for Payer: Cash Price |
$2,201.40
|
| Rate for Payer: Cash Price |
$2,201.40
|
| Rate for Payer: Cash Price |
$2,201.40
|
| Rate for Payer: Cash Price |
$2,201.40
|
| Rate for Payer: Central Health Plan Commercial |
$3,913.60
|
| Rate for Payer: Cigna of CA PPO |
$3,620.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Dignity Health Media |
$2,919.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,211.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,941.55
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,919.67
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,919.67
|
| Rate for Payer: Galaxy Health WC |
$4,158.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,935.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,402.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,669.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,788.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,919.67
|
| Rate for Payer: InnovAge PACE Commercial |
$4,379.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,262.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,919.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$978.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,912.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,912.36
|
| Rate for Payer: Multiplan Commercial |
$3,669.00
|
| Rate for Payer: Networks By Design Commercial |
$3,179.80
|
| Rate for Payer: Prime Health Services Commercial |
$4,158.20
|
| Rate for Payer: Prime Health Services Medicare |
$3,094.85
|
| Rate for Payer: Riverside University Health System MISP |
$3,211.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,935.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,446.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,446.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,446.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,446.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,211.64
|
| Rate for Payer: Vantage Medical Group Senior |
$2,919.67
|
|
|
HC EYE EXAM & TREAT W/CON SED LTD
|
Facility
|
IP
|
$4,892.00
|
|
|
Service Code
|
CPT 92019
|
| Hospital Charge Code |
900501662
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$978.40 |
| Max. Negotiated Rate |
$4,402.80 |
| Rate for Payer: Cash Price |
$2,201.40
|
| Rate for Payer: Central Health Plan Commercial |
$3,913.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,956.80
|
| Rate for Payer: Galaxy Health WC |
$4,158.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,935.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,402.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,262.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,863.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$978.40
|
| Rate for Payer: Multiplan Commercial |
$3,669.00
|
| Rate for Payer: Networks By Design Commercial |
$3,179.80
|
| Rate for Payer: Prime Health Services Commercial |
$4,158.20
|
|
|
HC EYE EXAM & TREAT W/CON SED LTD
|
Facility
|
IP
|
$4,892.00
|
|
|
Service Code
|
CPT 92019
|
| Hospital Charge Code |
900501662
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$978.40 |
| Max. Negotiated Rate |
$4,402.80 |
| Rate for Payer: Cash Price |
$2,201.40
|
| Rate for Payer: Central Health Plan Commercial |
$3,913.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,956.80
|
| Rate for Payer: Galaxy Health WC |
$4,158.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,935.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,402.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,262.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,863.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$978.40
|
| Rate for Payer: Multiplan Commercial |
$3,669.00
|
| Rate for Payer: Networks By Design Commercial |
$3,179.80
|
| Rate for Payer: Prime Health Services Commercial |
$4,158.20
|
|
|
HC EYE EXAM & TREAT W/CON SED LTD
|
Facility
|
IP
|
$4,892.00
|
|
|
Service Code
|
CPT 92019
|
| Hospital Charge Code |
900501662
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$978.40 |
| Max. Negotiated Rate |
$4,402.80 |
| Rate for Payer: Cash Price |
$2,201.40
|
| Rate for Payer: Central Health Plan Commercial |
$3,913.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,956.80
|
| Rate for Payer: Galaxy Health WC |
$4,158.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,935.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,402.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,262.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,863.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$978.40
|
| Rate for Payer: Multiplan Commercial |
$3,669.00
|
| Rate for Payer: Networks By Design Commercial |
$3,179.80
|
| Rate for Payer: Prime Health Services Commercial |
$4,158.20
|
|
|
HC EYE FOR FOREIGN BODY
|
Facility
|
OP
|
$437.00
|
|
|
Service Code
|
CPT 70030
|
| Hospital Charge Code |
909001113
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$46.89 |
| Max. Negotiated Rate |
$393.30 |
| Rate for Payer: Adventist Health Medi-Cal |
$113.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$113.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$88.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$107.89
|
| Rate for Payer: Blue Distinction Transplant |
$262.20
|
| Rate for Payer: Blue Shield of California Commercial |
$270.07
|
| Rate for Payer: Blue Shield of California EPN |
$212.38
|
| Rate for Payer: Caremore Medicare Advantage |
$113.54
|
| Rate for Payer: Cash Price |
$196.65
|
| Rate for Payer: Cash Price |
$196.65
|
| Rate for Payer: Central Health Plan Commercial |
$349.60
|
| Rate for Payer: Cigna of CA HMO |
$279.68
|
| Rate for Payer: Cigna of CA PPO |
$323.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: Dignity Health Media |
$113.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.28
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$113.54
|
| Rate for Payer: Galaxy Health WC |
$371.45
|
| Rate for Payer: Global Benefits Group Commercial |
$262.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$393.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$327.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$186.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$187.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$113.54
|
| Rate for Payer: InnovAge PACE Commercial |
$170.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$291.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$152.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$152.14
|
| Rate for Payer: Multiplan Commercial |
$327.75
|
| Rate for Payer: Networks By Design Commercial |
$284.05
|
| Rate for Payer: Prime Health Services Commercial |
$371.45
|
| Rate for Payer: Prime Health Services Medicare |
$120.35
|
| Rate for Payer: Riverside University Health System MISP |
$124.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$262.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$262.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC EYE FOR FOREIGN BODY
|
Facility
|
IP
|
$437.00
|
|
|
Service Code
|
CPT 70030
|
| Hospital Charge Code |
909001113
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$87.40 |
| Max. Negotiated Rate |
$393.30 |
| Rate for Payer: Cash Price |
$196.65
|
| Rate for Payer: Central Health Plan Commercial |
$349.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$174.80
|
| Rate for Payer: Galaxy Health WC |
$371.45
|
| Rate for Payer: Global Benefits Group Commercial |
$262.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$393.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$291.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$166.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.40
|
| Rate for Payer: Multiplan Commercial |
$327.75
|
| Rate for Payer: Networks By Design Commercial |
$284.05
|
| Rate for Payer: Prime Health Services Commercial |
$371.45
|
|
|
HC EYE PARACENTESIS W/RELEASE AQU
|
Facility
|
OP
|
$7,667.00
|
|
|
Service Code
|
CPT 65800
|
| Hospital Charge Code |
900501304
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$149.26 |
| Max. Negotiated Rate |
$6,900.30 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,202.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,911.63
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$4,600.20
|
| Rate for Payer: Caremore Medicare Advantage |
$2,911.63
|
| Rate for Payer: Cash Price |
$3,450.15
|
| Rate for Payer: Cash Price |
$3,450.15
|
| Rate for Payer: Cash Price |
$3,450.15
|
| Rate for Payer: Cash Price |
$3,450.15
|
| Rate for Payer: Central Health Plan Commercial |
$6,133.60
|
| Rate for Payer: Cigna of CA PPO |
$5,673.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Dignity Health Media |
$2,911.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,202.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,930.70
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,911.63
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,911.63
|
| Rate for Payer: Galaxy Health WC |
$6,516.95
|
| Rate for Payer: Global Benefits Group Commercial |
$4,600.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,900.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,750.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,775.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,911.63
|
| Rate for Payer: InnovAge PACE Commercial |
$4,367.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,113.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$149.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,911.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,533.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,901.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,901.58
|
| Rate for Payer: Multiplan Commercial |
$5,750.25
|
| Rate for Payer: Networks By Design Commercial |
$4,983.55
|
| Rate for Payer: Prime Health Services Commercial |
$6,516.95
|
| Rate for Payer: Prime Health Services Medicare |
$3,086.33
|
| Rate for Payer: Riverside University Health System MISP |
$3,202.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,600.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,833.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,833.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,833.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,833.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,202.79
|
| Rate for Payer: Vantage Medical Group Senior |
$2,911.63
|
|
|
HC EYE PARACENTESIS W/RELEASE AQU
|
Facility
|
IP
|
$7,667.00
|
|
|
Service Code
|
CPT 65800
|
| Hospital Charge Code |
900501304
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,533.40 |
| Max. Negotiated Rate |
$6,900.30 |
| Rate for Payer: Cash Price |
$3,450.15
|
| Rate for Payer: Central Health Plan Commercial |
$6,133.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,066.80
|
| Rate for Payer: Galaxy Health WC |
$6,516.95
|
| Rate for Payer: Global Benefits Group Commercial |
$4,600.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,900.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,113.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,921.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,533.40
|
| Rate for Payer: Multiplan Commercial |
$5,750.25
|
| Rate for Payer: Networks By Design Commercial |
$4,983.55
|
| Rate for Payer: Prime Health Services Commercial |
$6,516.95
|
|
|
HC EYE PARACENTESIS W/RML VITREOU
|
Facility
|
OP
|
$8,795.00
|
|
|
Service Code
|
CPT 65810
|
| Hospital Charge Code |
900501528
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$8,114.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,202.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,911.63
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Blue Distinction Transplant |
$5,277.00
|
| Rate for Payer: Caremore Medicare Advantage |
$2,911.63
|
| Rate for Payer: Cash Price |
$3,957.75
|
| Rate for Payer: Cash Price |
$3,957.75
|
| Rate for Payer: Cash Price |
$3,957.75
|
| Rate for Payer: Cash Price |
$3,957.75
|
| Rate for Payer: Central Health Plan Commercial |
$7,036.00
|
| Rate for Payer: Cigna of CA PPO |
$6,508.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Dignity Health Media |
$2,911.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,202.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,930.70
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,911.63
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,911.63
|
| Rate for Payer: Galaxy Health WC |
$7,475.75
|
| Rate for Payer: Global Benefits Group Commercial |
$5,277.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,915.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,596.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,775.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,911.63
|
| Rate for Payer: InnovAge PACE Commercial |
$4,367.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,866.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$640.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,911.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,759.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,901.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,901.58
|
| Rate for Payer: Multiplan Commercial |
$6,596.25
|
| Rate for Payer: Networks By Design Commercial |
$5,716.75
|
| Rate for Payer: Prime Health Services Commercial |
$7,475.75
|
| Rate for Payer: Prime Health Services Medicare |
$3,086.33
|
| Rate for Payer: Riverside University Health System MISP |
$3,202.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,277.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,397.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,397.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,397.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,397.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,202.79
|
| Rate for Payer: Vantage Medical Group Senior |
$2,911.63
|
|
|
HC EYE PARACENTESIS W/RML VITREOU
|
Facility
|
IP
|
$8,795.00
|
|
|
Service Code
|
CPT 65810
|
| Hospital Charge Code |
900501528
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,759.00 |
| Max. Negotiated Rate |
$7,915.50 |
| Rate for Payer: Cash Price |
$3,957.75
|
| Rate for Payer: Central Health Plan Commercial |
$7,036.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,518.00
|
| Rate for Payer: Galaxy Health WC |
$7,475.75
|
| Rate for Payer: Global Benefits Group Commercial |
$5,277.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,915.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,866.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,350.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,759.00
|
| Rate for Payer: Multiplan Commercial |
$6,596.25
|
| Rate for Payer: Networks By Design Commercial |
$5,716.75
|
| Rate for Payer: Prime Health Services Commercial |
$7,475.75
|
|
|
HC EYE SERVICE ORPROCEDURE
|
Facility
|
IP
|
$298.00
|
|
|
Service Code
|
CPT 92499
|
| Hospital Charge Code |
900501542
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$59.60 |
| Max. Negotiated Rate |
$268.20 |
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Central Health Plan Commercial |
$238.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$119.20
|
| Rate for Payer: Galaxy Health WC |
$253.30
|
| Rate for Payer: Global Benefits Group Commercial |
$178.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$268.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$198.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.60
|
| Rate for Payer: Multiplan Commercial |
$223.50
|
| Rate for Payer: Networks By Design Commercial |
$193.70
|
| Rate for Payer: Prime Health Services Commercial |
$253.30
|
|
|
HC EYE SERVICE ORPROCEDURE
|
Facility
|
OP
|
$298.00
|
|
|
Service Code
|
CPT 92499
|
| Hospital Charge Code |
900501542
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$37.20 |
| Max. Negotiated Rate |
$2,696.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$55.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$178.80
|
| Rate for Payer: Caremore Medicare Advantage |
$37.20
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Central Health Plan Commercial |
$238.40
|
| Rate for Payer: Cigna of CA PPO |
$220.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55.80
|
| Rate for Payer: Dignity Health Media |
$37.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.22
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$37.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$37.20
|
| Rate for Payer: Galaxy Health WC |
$253.30
|
| Rate for Payer: Global Benefits Group Commercial |
$178.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$268.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$223.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$61.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.20
|
| Rate for Payer: InnovAge PACE Commercial |
$55.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$198.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$49.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$49.85
|
| Rate for Payer: Multiplan Commercial |
$223.50
|
| Rate for Payer: Networks By Design Commercial |
$193.70
|
| Rate for Payer: Prime Health Services Commercial |
$253.30
|
| Rate for Payer: Prime Health Services Medicare |
$39.43
|
| Rate for Payer: Riverside University Health System MISP |
$40.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$178.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$149.00
|
| Rate for Payer: United Healthcare All Other HMO |
$149.00
|
| Rate for Payer: United Healthcare HMO Rider |
$149.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$149.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$55.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: Vantage Medical Group Senior |
$37.20
|
|
|
HC FACIAL BONES COMPLETE
|
Facility
|
OP
|
$1,527.00
|
|
|
Service Code
|
CPT 70150
|
| Hospital Charge Code |
909001101
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$70.83 |
| Max. Negotiated Rate |
$1,374.30 |
| Rate for Payer: Adventist Health Medi-Cal |
$137.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$169.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$163.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$199.83
|
| Rate for Payer: Blue Distinction Transplant |
$916.20
|
| Rate for Payer: Blue Shield of California Commercial |
$943.69
|
| Rate for Payer: Blue Shield of California EPN |
$742.12
|
| Rate for Payer: Caremore Medicare Advantage |
$137.36
|
| Rate for Payer: Cash Price |
$687.15
|
| Rate for Payer: Cash Price |
$687.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,221.60
|
| Rate for Payer: Cigna of CA HMO |
$977.28
|
| Rate for Payer: Cigna of CA PPO |
$1,129.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$1,297.95
|
| Rate for Payer: Global Benefits Group Commercial |
$916.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,374.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,145.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$225.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$226.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: InnovAge PACE Commercial |
$206.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,018.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$305.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$1,145.25
|
| Rate for Payer: Networks By Design Commercial |
$992.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,297.95
|
| Rate for Payer: Prime Health Services Medicare |
$145.60
|
| Rate for Payer: Riverside University Health System MISP |
$151.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$916.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$916.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC FACIAL BONES COMPLETE
|
Facility
|
IP
|
$1,527.00
|
|
|
Service Code
|
CPT 70150
|
| Hospital Charge Code |
909001101
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$305.40 |
| Max. Negotiated Rate |
$1,374.30 |
| Rate for Payer: Cash Price |
$687.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,221.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$610.80
|
| Rate for Payer: Galaxy Health WC |
$1,297.95
|
| Rate for Payer: Global Benefits Group Commercial |
$916.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,374.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,018.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$581.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$305.40
|
| Rate for Payer: Multiplan Commercial |
$1,145.25
|
| Rate for Payer: Networks By Design Commercial |
$992.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,297.95
|
|
|
HC FACIAL BONES LIMITED
|
Facility
|
IP
|
$1,020.00
|
|
|
Service Code
|
CPT 70140
|
| Hospital Charge Code |
909001102
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$204.00 |
| Max. Negotiated Rate |
$918.00 |
| Rate for Payer: Cash Price |
$459.00
|
| Rate for Payer: Central Health Plan Commercial |
$816.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$408.00
|
| Rate for Payer: Galaxy Health WC |
$867.00
|
| Rate for Payer: Global Benefits Group Commercial |
$612.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$918.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$680.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$388.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$204.00
|
| Rate for Payer: Multiplan Commercial |
$765.00
|
| Rate for Payer: Networks By Design Commercial |
$663.00
|
| Rate for Payer: Prime Health Services Commercial |
$867.00
|
|
